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Use of complementary medicine linked to greater risk for cancer death
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The use of complementary medicine for the treatment of lung, breast, prostate or colorectal cancer appeared associated with refusal of conventional cancer treatment and almost double the risk for death compared with adherence to conventional cancer treatment, according to results of a retrospective, observational study.
The higher mortality risk associated with complementary medicine may be driven by the higher rates of treatment refusal than by the treatments themselves.
“The use of complementary and alternative medicine is estimated to be a multibillion dollar industry in the United States,” Skyler B. Johnson, MD, chief resident in radiation oncology at Yale School of Medicine, and colleagues wrote. “Its growth has been attributed to its increased availability and marketing as well as congruence with patients’ beliefs, values and philosophies regarding their health, especially the desire for direct self-autonomy. Complementary medicine is used in addition to conventional cancer therapy and may be used as a substitute for adjuvant therapies.”
Researchers used data from the National Cancer Database to compare 258 patients who used complementary medicine with 1,031 matched controls who did not. All patients were diagnosed with nonmetastatic breast, prostate, lung or colorectal cancer from 2004 to 2013.
Researchers defined complementary medicine as other or unproven cancer treatments administered by nonmedical personnel, including herbs//botanicals, vitamins/minerals, traditional Chinese medicine, specialized diets, homeopathy and naturopathy.
Compared with those who did not use complementary medicine, patients who used complementary medicine appeared more likely to:
- be younger (mean age, 56 vs. 62 years; P < .001);
- be female (77.1% vs. 48.8%; P < .001);
- be of higher socioeconomic status ( $48,000 median household income based on zip code of residence; 67.6% vs. 61.4%; P < .001); and
- reside in the Intermountain West (10.6% vs. 4.4%; P < .001) or Pacific West (38.4% vs. 12.4%; P < .001).
Patients who used complementary medicine did not experience a longer delay to initiation of conventional cancer treatment (29 days vs. 28 days). However, patients who used complementary medicine had higher refusal rates for conventional cancer treatment, including refusal of:
- surgery (7% vs. 0.1%; P < .001);
- chemotherapy (34.1% vs. 3.2%; P <.001);
- radiotherapy (53% vs. 2.3%; P < .001); and
- hormone therapy (33.7% vs. 2.8%; P < .001).
Fewer patients who used complementary medicine achieved 5-year OS than those who did not (82.2% vs. 86.6%; P = .001).
Use of complementary medicine was independently associated with a twofold greater risk for death (HR = 2.08; 95% CI, 1.5-2.9) in a multivariate model that did not include treatment delay or refusal. However, in analyses that included treatment delay and treatment refusal, the association was no longer significant (HR = 1.39; 95% CI, 0.83-2.33).
The limitations of the study included its retrospective and observational nature, that assignment of complementary medicine differed significantly by facility and unmeasured potential confounders.
“We believe our work to be critically important to patients considering complementary medicine — a group that likely includes most patients with cancer,” the researchers wrote. “Given the hesitance on behalf of patients to disclose nonmedical therapy to their clinicians, health care professionals need to be proactive in discussing complementary medicine and adherence to conventional medicine treatment with their patients. For patients with curable cancers who are inclined to pursue complementary treatment methods, timely adherence to all recommended conventional therapies should be strongly advised.” – by Cassie Homer
Disclosures: Johnson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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